Day 2 :
Keynote Forum
Michael Friebe
Otto-von-Guericke-University,Germany
Keynote: Conceptual idea for brain tumour treatment through intra-arterial pathways
Time : 09:00-09:20
Biography:
Prof. Michael Friebe, PhD, has been involved in diagnostic imaging and image guided therapeutic products and services, asrnfounder / innovator / CEO investor, and scientist. Dr. Friebe currently is a Board Member of two startup R&D companies, as wellrnas investment partner of a medical technology startup-fund. He is an affiliated professor with the chair for Computer AidedrnMedical Procedures (CAMP) at TU München, and full professor of Image Guided Therapies at the Otto-von-Guericke-Universityrnin Magdeburg, Germany. He is listed inventor of more than 60 patent applications and the author of numerous papers
Abstract:
There are many invasive (removal of the tumour tissuernthrough skull based access) and non-invasive medicalrntreatment strategies (mainly radiation therapy). Very oftenrnalso a combination of both.rnWe have created a new device, that would allow usingrnthe vascular structure as a possible pathway for treatingrnintracranial diseases. One option would be the placement ofrnradiation seeds directly into a brain tumour. The main issuesrnwith this catheter based approach are the defined puncture ofrnthe vessel, the prevention of liquid exchange (blood / brain),rnsealing of the vessel after the procedure, and the accuraternplacement and control of the procedure using externalrndiagnostic imaging.rnThe catheter based device (see figure), guided andrncontrolled by 3D X-ray (Artis Zeego, Siemens Healthcare,rnErlangen, Germany), is presented consisting of a one-sidedrntriple-hole balloon, a tube feeding this balloon and a secondrntube combined with a guide assistant for the puncture andrntreatment. 3D shaped X-ray markers allow accuraternplacement.rnThe presented pathway could be an alternative tumourrnaccess and particularly well suited for placements of smallrnradioactive seeds.
Keynote Forum
Dongwoo John chang
CIGNA, Hospital, USA
Keynote: THE SUBTEMPORAL APPROACH IN CRANIAL NEUROSURGERY: A ROAD LESS TRAVELED
Time : 09:00-02:30
Biography:
Dr.Dongwoo John chang
Abstract:
THE SUBTEMPORAL APPROACH IN CRANIAL NEUROSURGERY: A ROAD LESS TRAVELED rnINTRODUCTIONrnThe subtemporal approach was popularized by Dr. Charles Drake for the microneurosurgical clipping of aneurysms of the distal basilar artery. The competing approach for such problems was and still is the transsylvian approach to the interpeduncular region. Because an increasing proportion of cerebral aneurysms, particularly those of the basilar artery, are treated by endovascular methods, it is probable that the subtemporal approach is being used less and less in contemporary neurosurgical practice. However, the elegance of this approach lends itself to the neurosurgical treatment of not only vascular lesions, but also for the definitive microsurgical management of tumorous lesions that occur in the deep, central portions of the cranial cavity.rnMETHODSrnRetrospective review of the clinical practice database of a single cerebrovascular/skull base neurosurgeon revealed that the following lesions were treated with the subtemporal approach and its variations: basilar apex aneurysm (small to giant sizes clipped with standard techniques and with hypothermic circulatory standstill), superior cerebellar artery aneurysm, posterior cerebral artery aneurysm, tentorial meningioma, parahippocampal (and other subtemporal) metastatic tumor, large mesencephalic lymphoma, giant pontomesencephalic region pilocytic astrocytoma, and chordoma.rnRESULTSrnThe subtemporal approach can be subdivided into 3 subcategories: (1) anterior subtemporal, (2) mid-subtemporal, and (3) posterior subtemporal. Excellent microsurgical exposure was obtained in all cases approached with each of the 3 variations of the subtemporal approach. Definitive lesionectomy (whether it was aneurysm clipping, lesion biopsy, or tumoral removal) was accomplished in all cases. Technical nuances to avoid surgical complications are discussed in this presentation, ranging from (and including) bony exposure, lumbar drainage, location/method of tentorial incision, and management of cerebral veins to the optimal mechanical trajectories of brain retractors that facilitate final surgical exposure while minimizing iatrogenic brain injury. The specific surgical approach was tailored to the anatomic details of the treated lesion—based on vascular, bony, and lesional anatomy—to arrive at the most applicable surgical approach.rnCONCLUSIONSrnThe subtemporal approaches provide orthogonal anatomic routes that often result in a short, direct route to neurosurgical lesions that occur at the tentorial incisura and in the interpeduncular cistern. The subtemporal approaches are useful for lesions that may originate in different anatomic compartments but have lesional extensions into the traditional “central†cranial compartment (pontomesencephalic, clival, and tentorial incisural regions), for which the classical subtemporal approach has been historically useused. Finally, anatomic insights gained from the use of the subtemporal approaches are particularly useful in the microneurosurgery of the mesial temporal lobe region, and vice versa.rn
- Brain Cancer
Session Introduction
Homayoun Hadizadeh Kharazi
Iran University of Medical Science
Title: The rule of imaging in Brain Tumor
Biography:
Homayoun Hadizadeh Kharazi has completed his Residency at the age of 34 years from Tehran Medical University and fellowship studies from Harvard Medical University School of Medicine. He is the director of Chairman of Radiology for 11 years in Iran Medical School, a premier. He has published more than 15 papers.
Abstract:
The rule of imaging in detecting grading, prognosis, post op. Evaluation and also post chemotherapy and post radiation: The rule of imaging in brain mass and post op., post radiation changes is a challenging subject. In this lecture I am going to show the benefit and weak point of conventional MRI with and without Gd. And shows the advantages and disadvantage of new technique including DWI, SWI, ASL and MRS and compare these new techniques to show the weak and positive points in each technique. In conventional MRI the size, signal intensity and enhancement of the lesion is challenging in term of pre operation or post operation/post radiation or post chemotherapy changes. MRS, DTI, SWI, DWI and ADC Map could be helpful.
Ehtesham Ghani,
Institute King Fahad Medical City Riyadh, Kingdom of Saudi
Title: Intracranial cystic meningiomas: a rare type of tumours
Biography:
Ehtesham Ghani MBBS, FCPS (Neurosurgery), Mahmoud Al-Yamany MD, FRCS (C),Affiliation: Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.Assistant Consultant in the Department of Neurosurgery at National Neuroscience Institute
Abstract:
Introduction: Intracranial cystic meningiomas are rare and preoperative diagnosis is difficult. The present study was performed to assess the clinical and radiological outcome of intracranial cystic meningiomas. Methods: We performed a retrospective analysis of 13 patients (mean age: 49.9 years) who underwent surgical resection of intracranial cystic meningiomas from January 2006 to February 2014. There were 5 male and 8 female patients. The Glasgow Outcome Scale was used to assess the clinical outcome at 6 months. Results: Headache was the main presenting clinical feature. Most of the tumours were located on the right side. The frontal convexity was the most common site. Gross total resection was performed in 10 patients. The most common histopathological type was meningothelial variety. Conclusion: Intracranial cystic meningiomas are usually benign that occur in relatively young patients. Resection of cysts that show contrast enhancement is essential to reduce recurrence. Key words: intracranial cystic meningioma, intratumoural cystic meningioma, peritumoural cystic meningioma, meningothelial meningioma.
Sdahan Majumder
M. D. Anderson Cancer Center
Title: Mir-21–Sox2 axis delineates glioblastoma subtypes with prognostic impact
Biography:
Sadhan Majumder is a Professor of Genetics and Neuro-Oncology at M. D. Anderson Cancer Center, Houston, TX 77030, USA
Abstract:
Glioblastoma is the most aggressive human brain tumor. Although several molecular subtypes of glioblastoma are recognized, a robust molecular prognostic marker has yet to be identified. Here we report that the stemness regulator Sox2 is a new, clinically important target of microRNA-21 (miR-21) in glioblastoma, with implications for prognosis. Using the miR-21–Sox2 regulatory axis, about half of all glioblastoma tumors present in The Cancer Genome Atlas (TCGA) and in-house patient databases can be mathematically classified into high miR-21/low Sox2 (Class A) or low miR-21/high Sox2 (Class B) subtypes. This classification reflects phenotypically and molecularly distinct characteristics and is not captured by existing classifications. Supporting the distinct nature of the subtypes, gene set enrichment analysis of the TCGA dataset predicted that Class A and Class B tumors were significantly involved in immune/inflammatory response and in chromosome organization and nervous system development, respectively. Patients with Class B tumors had longer overall survival than those with Class A tumors. Analysis of both databases indicated that the Class A/Class B classification is a better predictor of patient survival than currently used parameters. Further, manipulation of miR-21–Sox2 levels in orthotopic mouse models supported the longer survival of the Class B subtype. The miR-21–Sox2 association was also found in mouse neural stem cells and in the mouse brain at different developmental stages, suggesting a role in normal development. Thus, this mechanism-based classification suggests the presence of two distinct populations of glioblastoma patients with distinguishable phenotypic characteristics and clinical outcomes.
- Pediatric Neuro-oncology and Radiation Oncology
Session Introduction
Rheal A. Towner,
Oklahoma Medical Research Foundation, USA
Title: OKN-007 is a New Therapeutic Approach for Adult and Pediatric Glioblastomas
Biography:
Dr. Towner has completed his PhD at the age of 33 years from the University of Guelph in Canada and postdoctoral studies from the University of Queensland in Australia. He is the director of Advanced Magnetic Resonance Center at the Oklahoma Medical Research Foundation, a premier biomedical research institution. He has published more than 127 papers in reputed journals and has been serving as a charter member of the National Institutes of Health Clinical Molecular Imaging and Probe development (CMIP) study section, and an editorial board member of repute.
Abstract:
OKN-007 is a New Therapeutic Approach for Adult and Pediatric Glioblastomas: Adult glioblastomas (aGBM) are the most common malignant primary brain tumors worldwide. Pediatric glioblastomas (pGBM) are one of the leading causes of cancer-related deaths in children, with tumors essentially refractory to existing treatments. OKN-007 is a novel nitrone-based compound that has anti-cancer activity in both adult and pediatric GBM. Magnetic resonance imaging (MRI) techniques were used to assess the efficacy of OKN-007 in orthotopic aGBM rat (C6, F98) and mouse (GL261) models, as well as human xenograft aGBM rat (U87) and pGBM mouse (IC-3752GBM) models. OKN-007 was found to significantly decrease tumor volumes and increase animal survival in OKN-007-treated rodents compared to untreated animals, and increase diffusion and perfusion rates. OKN-007 also significantly reduced lipid tumor metabolism, and as significantly decreased tumor cell proliferation and microvessel density. Immunohistochemistry support data was also obtained for cell proliferation and tumor growth signaling. Microarray data indicates that OKN-007 in aGBM model is centrally controlled by the TGFβ1 (transforming growth factor β1) pathway. For pGBM, in relationship to the PDGFRα (platelet-derived growth factor receptor-α) pathway, OKN-007 was able to significantly decrease PDGFR-α and SULF2 immunoexpression, and significantly increase decorin expression. This study indicates that OKN-007 may be an effective anti-cancer agent for adult or pediatric patients with aGBMs or pGBMs, respectively by inhibiting cell proliferation and angiogenesis, possibly via the TGFβ1 and/or PDGFRα pathways, and could be considered as an additional therapy for both adult or pediatric brain tumor patients.
- Neurosurgery
Session Introduction
Dongwoo John chang
Medical Director Neurosurgery and Spinal Surgery-CIGNA USA
Title: THE SUBTEMPORAL APPROACH IN CRANIAL NEUROSURGERY: A ROAD LESS TRAVELED
Biography:
Dongwoo John chang currently in a position Medical Director Neurosurgery and Spinal Surgery-CIGNA USA
Abstract:
Chronic pain syndrome (CPS) is currently seen as an independent disease requiring etiopathogenetic treatment. Optimal way for cancer patients is opioid therapy. By reason of permanent presence of symptoms, the method of choice are implantable close sterile systems that do not require regular invasive procedures with minimal side «opioid» effects, that allow to stop strong pain, including "breakthrough pain." Thus the functional neurosurgery takes the increasing place in oncology. First experience in Russia applying programmable morphine infusion pumps for severe cancer pain belonged to P.Herzen Moscow Oncology Research Institute. The most significant indications for pump implantation were: the presence of heavy cancer pain (VAS>60), inefficiency of previous narcotic analgesics at doses equivalent to 30 mg morphine, life expectancy more than 3 months, and positive morphine test. Morphine pump installed 62 patients in 2013-2015. All patients diagnosed with CPS intensity of 60-100 % by VAS (average 91,6 ± 6,9), 28 patients had severe neyropatic pain. Side effects of opioid therapy were present in all patients. Implantation and pump programming was carried out according to the accepted method. All the patient the intensity of pain in all patients decreased to 0-20 % by VAS (p-value= 0,000301). Morphine dose vary from 180 to 9500 mg/day. All treated patients completely stopped taking opioids. We registered increase of motion activity in 51 cases, absence of sedation effects, improved somatic status. However, 26 patients with a long history of receiving opioid (over six months) from the second day developed specific withdrawal symptoms caused by the termination of systemic effects of opiates, requiring symptomatic therapy for 4-10 days. All patients reported more effective pain relief, lack of systemic side effects and increase quality of life after the selection of the Individual mode morphine pump. In patients with refractory cancer pain, intrathecal drug therapy with programmable morphine pumps is associated with improved pain reporting, reduced breakthrough pain and a significant improvement in the quality of life.
Ganesh Kumar Chettiar,
Kasturba Medical College, India
Title: Morphometric study of corpus callosum in South Indian cadavers
Biography:
Dr. Ganesh Kumar Chettiar has completed his MD at the age of 37 years from Manipal University. He is an Associate Professor in the Department of Anatomy. He has published more than 25 papers in reputed journals.
Abstract:
Corpus callosum is the largest commissural type of white fiber which connects the two cerebral hemispheres. The purpose was to measure the dimensions of corpus callosum and its parts and also to know its location in the cerebral hemisphere of South Indian cadavers. Twenty mid-sagittal sections from formalin fixed brain specimens were used for this study and the parameters recorded were: distances from frontal pole to occipital pole (AB), inferior surface to the superior surface of the brain (CD), frontal pole of brain to genu (AG), occipital pole to splenium of corpus calloum (BS), from splenium to superior colliculus (Ls-SC) and inferior colliculus (Ls-IC), genu to fornix (GF), outer curvature O (G-S) and inner curvature I (G-S) from genu to splenium, the entire outer curvature (OUTCR) and inner curvature (INCUR) from beginning of rostrum to the end of splenium. We also measured the thickness of rostrum (R), genu (G), trunk (T), isthmus (I) and splenium (S). Statistical analysis showed significant correlation between A-B and B-S, O (G-S) and INCUR,O (G-S) and OUTCR, A-G and R, T and I. Highly significant correlation were found between C-D and Ls-IC, O (G-S) and I (G-S), I (G-S) and G-F, G-F and G. Very highly significant correlation were seen between I (G-S) and INCUR, Ls-SC and Ls-IC, T and S. This study on the morphometry could provide valuable data in the diagnosis of any lesions of the corpus callosum and we believe that the data are enlightening to the neurosurgeons and radiologists.
- Tumour Heterogeneity
Session Introduction
Usman Ali,
professor in neurology United states
Title: Multiple ring enhancing lesions on MRI of the brain in transplant recipient: A diagnostic dilemma
Biography:
Dr.usman Ali is an professor in neurology department ans as well as an a surgeon who has done many publications under Multiple ring enhancing lesions on MRI of the brain in transplant recipient: A diagnostic dilemma
Abstract:
Post-transplantation primary central nervous system lymphoma (PT-PCNSL) is a very rare tumor that can present from months to years after transplantation. Although it is frequently encountered in a renal transplant recipient, can certainly present in liver and other solid organ transplant recipients too. Its symptoms can be varied ranging from non-specific symptoms such as headache, gait disturbance, change in mental status to the focal neurological deficit. Inflammatory markers such as C-reactive protein, LDH, and ESR may be elevated whereas CSF analysis often is inconclusive. MRI is a better diagnostic modality than CT; however, it can still be difficult to diagnose accurately these ring-enhancing lesions given the wide-range of the differential. As a result, brain biopsy becomes mandatory to establish the diagnosis in most cases. Here we present a case of PT-PCNSL, who was initially misdiagnosed and treated as brain abscess until brain biopsy proved it otherwise Case: A 41-year-old Hispanic female with a past medical history of bacterial endocarditis, renal transplant (1994) secondary to glomerulonephritis treated with mycophenolate and tacrolimus presented with a transient change in mental status. She had stable vitals without neurological deficits and the spontaneous return of baseline mental status. Her MRI showed two ring-enhancing lesions in the right temporal and parietal lobe. Considering her previous history of endocarditis, current immunosuppression, MRI findings and non-specific neurological manifestation, she was treated as a brain abscess without any significant response. Her blood culture remained negative, and CSF analysis was unremarkable. Therefore, she underwent brain biopsy that characterized it to be diffuse large B-cell lymphoma that was assumed to be post-transplant. Her immunosuppression was withheld; subsequently she underwent tumor resection followed by Rituximab therapy with an effective response, and she is currently disease free Discussion: Although PT –PCNSL is a very rare entity, it is increasingly recognized in transplant recipient as the number of transplant recipients rises, and better survival outcomes are achieved. Early diagnosis is a harbinger of a better outcome. Therefore high index of clinical suspicion should always be exercised in this patient population. Chronic immunosuppression plays a critical role in the etiopathogenesis of these neoplasms and often, the treatment is withholding immunosuppression itself. PT-PCNSL is hard to diagnose, easy to miss and rather difficult to treat with variable prognosis Although the differential diagnosis of ring-enhancing lesions on MRI includes glioma, metastatic malignant lesions, bacterial and non-bacterial abscesses, toxoplasmosis, and multiple sclerosis plaques, clinicians must consider PT-PNCSL highly in transplant recipients.